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Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study

Author

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  • Rami K. Aldwikat

    (School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220, Australia
    Centre for Quality and Patient Safety Research, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
    Operating Theatre, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia)

  • Elizabeth Manias

    (School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
    Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia)

  • Alex. Holmes

    (Department of Psychiatry, The University of Melbourne, Parkville, VIC 3010, Australia
    Department of Mental Health, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia)

  • Emily Tomlinson

    (School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220, Australia
    Centre for Quality and Patient Safety Research, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
    Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia)

  • Patricia Nicholson

    (School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220, Australia
    Centre for Quality and Patient Safety Research, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
    Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia)

Abstract

(1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A’s Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impact by improving the accuracy of delirium detection in the PACU and hence preventing adverse outcomes associated with delirium.

Suggested Citation

  • Rami K. Aldwikat & Elizabeth Manias & Alex. Holmes & Emily Tomlinson & Patricia Nicholson, 2022. "Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study," IJERPH, MDPI, vol. 19(23), pages 1-12, November.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:23:p:16020-:d:989321
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    References listed on IDEAS

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    1. Peter W. Lange & Marissa Lamanna & Rosie Watson & Andrea B. Maier, 2019. "Undiagnosed delirium is frequent and difficult to predict: Results from a prevalence survey of a tertiary hospital," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(13-14), pages 2537-2542, July.
    2. Rami K. Aldwikat & Elizabeth Manias & Patricia Nicholson, 2020. "Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study," Nursing & Health Sciences, John Wiley & Sons, vol. 22(4), pages 958-966, December.
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